Play to the Whistle: A Pilot Investigation of a Sports-Based Intervention for Traumatized Girls in Residential Treatment
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J Fam Viol
DOI 10.1007/s10896-013-9533-x
INNOVATION & FUTURE DIRECTIONS IN RESIDENTIAL TREATMENT OF TRAUMATIZED YOUTH
Play to the Whistle: A Pilot Investigation of a Sports-Based
Intervention for Traumatized Girls in Residential Treatment
Wendy D’Andrea & Lou Bergholz & Andrea Fortunato &
Joseph Spinazzola
# Springer Science+Business Media New York 2013
Abstract Adolescents in residential treatment settings have Children in residential treatment facilities frequently evidence
symptoms that prevent them from participation in normal severe behavior problems (Ford and Blaustein 2013; Jaffee
youth activities, which in turn prevent development of social and Gallop 2007; Knoverek et al. 2013; Zegers et al. 2008;
skills and competencies. A sports-based intervention called Zelechoski et al. 2013). Their emotional, interpersonal and
“Do the Good” (DtG) was designed for this population using behavioral problems often prevent them from engaging in
trauma-informed treatment principles. This paper describes “normal” teenage activity (Lyons et al. 2000). They may be
the intervention model and presents outcome data. A total of socially inappropriate and may evidence uncontrolled behav-
88 female residential students aged 12 to 21 participated, ior to the point of needing time-outs to regain self-control, or
including 62 students voluntarily enrolled in the sports league physical restraints to maintain safety (Hodgdon et al. 2013;
and 26 treatment-as-usual (TAU) comparisons. Positive be- Zegers et al. 2008). These problems often arise in the context
haviors (e.g., helping peers, perseverance) during games were of exposure to trauma in their family environment; conversely,
observed and coded for sports league participants and their such problems may prevent them from successful integration
coaches. Mental health charts of DtG and TAU participants into caring adoptive families.
were reviewed for behavior and symptoms prior to program `Over the past decade, a growing number of promising and
participation, and again post-program. Girls in the sports evidenced-based practices have been developed to treat trauma-
league exhibited reductions in restraints and time-outs, as well tized youth (Cohen et al. 2004; Ford and Cloitre 2009). Given
as internalizing and externalizing symptoms. These data pro- that traumatized youth experience complex problems, their care
vide evidence that sports-based interventions present a prom- often necessitates behavioral and environmental regulation strat-
ising adjunctive approach for traumatized youth. egies which result in social isolation with minimal physical or
intellectual stimulation. However, well-regulated and safe social
contact may also provide an important opportunity for skill
Keywords Posttraumatic stress disorder . Complex trauma . acquisition which may provide a base for re-integrating into
Sports . Adolescents . Residential treatment . Positive youth healthy social environments. Therefore, our goal is to examine
development whether sports can be successfully modified using trauma-
informed intervention principles. We will examine the impact
of a trauma-informed sports program on the well-being of
Author Note The authors would like to thank Susan Wayne, Johnna
Marcus, Hannah Flack and Jonathan DePierro for their contributions to trauma-exposed girls in residential treatment programs.
this manuscript. The first author would like to dedicate this paper to
memory of Dr. James Hansell (1955–2013), whose writing on sports and
psychotherapy informed and inspired the research presented here.
W. D’Andrea (*) : A. Fortunato Evidence-Based Practices for Complexly Traumatized
The New School, 80 5th Ave, 6th Floor, New York, Youth
NY 10009, USA
e-mail: dandreaw@newschool.edu
Complex trauma exposure is characterized by two elements: 1)
L. Bergholz it involves serial or repeated exposure to traumatic experiences
Edgework Consulting, Somerville, MA, USA or events; and 2) it most often occurs in the context of the
J. Spinazzola
caregiving environment (e.g., abuse, neglect or exposure to
The Trauma Center at Justice Resource Institute, domestic violence). In parallel, complex trauma symptoms
Brookline, MA, USA manifest as a delay of achieving developmental competencies
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including affect and behavior dysregulation, interpersonal dis- of DBT—mindfulness, emotion regulation, distress tolerance,
turbance, disturbance of attention and information processing, and interpersonal effectiveness—places heavy emphasis on
and somatic dysregulation (Cook et al. 2005). This spectrum of cultivation of the capacity for self-regulation and learning and
symptoms extends above and beyond, though frequently in- practice of a range of regulation skills.
cludes, Posttraumatic Stress Disorder (PTSD) and Major In contrast to the overarching goals of attachment, self-
Depressive Disorder, the commonly-recognized trauma sequel- regulation and self-efficacy in the ARC model, and the self-
ae following acute traumas (e.g., accidents or single-incident containment goals of DBT, PCIT works to help caregivers find
assaults). Furthermore, this spectrum of symptoms character- communication strategies to reduce oppositional and out-of-
izes a vast proportion of children in residential treatment and control behavior (Timmer et al. 2006; Urquiza and McNeil
juvenile justice settings (Jaycox et al. 2004; Marrow and 1996). This goal is attained through live-action coaching to
Buffington 2009; Shane et al. 2006). Because of the extreme caregivers in service of three main goals: 1) providing specif-
and pervasive nature of the symptoms experienced by com- ic, behaviorally-anchored expectations to children; 2) devot-
plexly traumatized children, their treatment needs require ex- ing positive attention to children during play; and 3) providing
ceptional creativity and comprehensive approaches. concrete, specific praise for positive behavior (Eyberg et al.
During the past several years, a handful of treatment models 1995). Used widely with maltreated children, PCIT has dem-
have been developed or adapted for use with children and onstrated efficacy across settings (Borrego et al. 2008; Matos
adolescents impacted by complex trauma (e.g., Ford et al. et al. 2006; Niec et al. 2005). The efficacy of PCIT with young
2007; Lieberman et al. 2006). Among these, three, in particular, children shows promise for an upward extension of this treat-
place heavy emphasis on the role of physiological and behav- ment with parents and adolescents.
ioral strategies of regulation in treatment process: Attachment,
Regulation and Competency (ARC; Hodgdon et al. 2013; Team Sports for Complexly-Traumatized Youth
Kinniburgh et al. 2005), Dialectical Behavior Therapy (DBT;
James et al. 2008; Linehan 1987), and Parent–child Interaction Recent research in sports psychology has examined the impact
Therapy (PCIT; Eyberg et al. 1995; Timmer et al. 2006). These of sports on positive youth development, particularly for at-
three treatments are comprised of several core components: risk youth. Studies have documented that physical activity in
building secure attachment relationships with adults and peers, general, and team sports in particular, have the potential to
developing competency at developmentally-appropriate tasks, help at-risk youth develop increased self-efficacy, improved
and self-regulating in the service of achieving goals. Moreover, peer relationships, better physical health, and more goal-
these protocolized approaches can combine to form a compre- directed activity (e.g., Branta and Goodway 1996; Petitpas
hensive treatment plan providing overall treatment goals and et al. 2004; Ratey 2008). The effects of physical activity on
framework (ARC), adolescent skills acquisition (DBT), and mental health are well established (Penedo and Dahn 2005);
caregiver intervention (PCIT). furthermore, sports have been used as way of teaching life
The ARC framework is explicitly designed for use with skills. For example, Sharpe et al. (1995) found that a sports
children who have experienced intense complex traumatization curriculum was able to increase participating students’ lead-
(Kinniburgh et al. 2005), and has been used with success ership and social skills.
among complexly traumatized children in foster care and res- Similarly, Branta and Goodway (1996) examined the im-
idential treatment settings (Arvidson et al. 2011; Hodgdon et al. pact of sports in a sample of urban at-risk youth whose
2013). Its therapeutic procedures include psychoeducation, behaviors featured aggression and poor social problem-
relationship strengthening, social skills, and parent–education solving. Experts in sports and mental health were deployed
training as well as psychodynamic interpretation, cognitive in schools with no physical education programs. Following
restructuring, behavioral modification, relaxation, expressive consultation with sports experts, teachers provided physical
arts and movement. Through building skills, stabilizing internal activities in the classroom and found a decrease in children’s
distress, and strengthening the security of the care giving aggressive behaviors. Furthermore, specific coaching behav-
system, interventions guided by this framework seek to provide iors seem to be a significant factor influencing the degree to
children with generalizing tools that enhance resilient outcome. which sports lead to positive youth development (e.g., Smith
DST is an empirically supported treatment for the reduction and Smoll 1996, 1997; Newton et al. 2007).
of general psychiatric symptoms and suicidal ideation in ad- Team sports may be an ideal method for delivering an
olescents (Rathus and Miller 2002). The DBT curriculum adjunctive treatment for severely traumatized children. Team
provides clients with concrete tools for regulating affects and sports have several elements. 1) They may be fun, and may be
meeting goals (Linehan et al. 1992). For example, in DBT, more engaging and motivating than standard psychotherapy.
clients are taught to specifically address concerns, to use 2) They are cooperative. Sports require peers to navigate
physical activity to regulate stress, and to be mindful of affects difficult social situations and to establish rapport with their
that influence behavior. Each of the four overarching modules coach, an authority figure and mentor. 3) They are skill-based,
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which may build competence and self-esteem. 4) They are to use “circle-ups” as time to provide specific expectations for
highly physically engaging. Children who are experiencing behaviors and game strategy. Taken together, the curriculum
hyperarousal symptoms consistent with PTSD may be able to provides player and caregiver (i.e., coach) goals and structure
mobilize their physiological activity in the service of a fun to not only create a successful recreational atmosphere, but to
activity. 5) They are goal-directed and require using higher work in conjunction with the therapeutic goals of each of the
cognitive functions of foresight, planning, impulse inhibition players.
and assessment of consequences. 6) They are easy to dissem- DtG has reformulated DBT modules for use on the playing
inate. Interventionists can be laypersons with minimal train- field. For example, mindfulness skills in DBT are transformed
ing, making them economical to deliver. 7) They can be into “show up” skills on the basketball court where players are
modified to incorporate techniques with known effectiveness. encouraged to be aware of their emotional reactions and use
Sports can incorporate principles of Dialectical Behavior them in service of their goals. Emotion regulation in DBT is
Therapy (DBT) such as emotion regulation, interpersonal found in “play to the whistle,” where players have to find
effectiveness, distress tolerance, and mindfulness; and, they ways to persevere despite frustration, and in “fill your tank,”
can also incorporate communication styles taught in PCIT. where positive reinforcement and re-defining of goals and
Therefore, trauma-informed sports may serve as an effective successes are used to de-escalate tension. Distress tolerance
adjunct treatment for adolescents. elements are found in “play to the whistle,” where players are
taught to keep up the play despite mistakes until their coach
Do the Good: A Trauma-Informed Sports Curriculum signals them to stop play. Finally, interpersonal effectiveness
for Adolescents in Residential Treatment Settings is taught in the “build your team” and “fill the tank” modules,
where players are taught to take responsibility for action,
One example of a trauma-informed sports curriculum, referred provide leadership and coaching to one another, and support
to as the “Do the Good” (DtG) program, was developed by a and praise one another.
collaboration between Justice Resource Institute and the second
author to serve as an adjunct to routine mental health services The Present Study
provided in residential settings for adolescents with histories of
severe emotional and behavioral problems. Given this intended Given that no research, to date, has examined the impact of
role as an ancillary component of residential treatment for these trauma-informed sports on youth residing in residential treat-
youth, DtG was designed to adhere to guidelines for Evidence- ment facilities, nor has it examined the impact of sports
Based Practices in Psychology (EBPP) established by the explicitly with a sample of maltreated adolescents, the goals
American Psychological Association (American Psychological of the present study are to present outcome data on a pilot
Association Presidential Task Force on Evidence-Based Practice examination of sports in this setting. In particular, we propose
2006) and to attend to the particular importance and challenges two goals: 1) to provide preliminary data on the intervention’s
of developing and implementing evidence-based practices for effects on its participants; and 2) to examine the capacity to
children and adolescents in naturalistic settings (Kendall and implement successfully the DtG therapeutic curriculum in a
Beidas 2007). Therapeutic skills selected for transmission sports league housed within youth residential treatment set-
through the DtG curriculum were drawn from clinical skill sets tings by examining player and coach behaviors. Briefly, the
for youth and their adult caregivers covered by well-established effectiveness of trauma-informed sports for girls in residential
empirically supported treatments for dysregulated youth, respec- treatment was evaluated through pre-post chart review of
tively. In the DtG curriculum, ARC provides the overall treat- participating and non-participating comparison student mental
ment philosophy; DBT principles provide the specific interven- health and treatment milieu behavioral data, and through live
tion content to teach to players; and PCIT principles provides the observation games played by a sports league comprised of
vehicle to help coaches deliver the content. residential schools.
The DtG curriculum draws upon the ARC framework to
guide its players to build competency, self-regulation and
strong player–team relationships. For example, the ARC phi- Method
losophy is used to help educate coaches about their players’
reactivity to stressors on and off the basketball court. The DtG Overview
curriculum draws from the PCIT model by providing live-
action coaching to coaches and through helping coaches Data was collected on the mental and behavioral health of
achieve the PCIT caregiver goals. Coaches are taught to students during the basketball season of the Doc Wayne
provide specific, behaviorally-linked praise immediately Athletic League, a DtG-based sports league for girls in residen-
when a behavior occurs; to spend time one-on-one with each tial treatment facilities that employs the trauma-informed sports
player as she comes off the court for substitutions in plays; and curriculum. Data was also collected from children who did not
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participate in league play but who were engaged in treatment at
the same residential schools as those playing in the league
(treatment as usual, or TAU). Observational data were collected
from six residential treatment facilities serving adolescent fe-
males aged 12 to 21, and chart data were acquired from three of
the six programs. Chart data were collected from children in the
league, as well as non-participating children in the residential
programs, to investigate change in sports-engaged students at
post-season compared to pre-season baseline data and com-
pared to non-participating peers. Furthermore, in order to pro-
vide data on the feasibility of implementation of the trauma-
informed sports curriculum, observation of both students and
coaches at each basketball game was used to determine wheth-
er coaches were implementing the program, and whether pro-
gram principles were employed with increasing frequency Fig. 1 Participant enrollment and data
throughout the season. All evaluation activities conducted for
this study were reviewed and approved by a certified
Institutional Review Board (IRB). with the state’s child protective service, and 90 % have histories
of abuse and/or neglect. In the present evaluation, inclusion as a
Participants DtG participant or comparison student was based upon enroll-
ment in one of the six participating residential treatment facil-
Evaluation participants consisted of 88 adolescent girls aged ities by the third week of the study intervention and continued
12 to 21 drawn from six residential treatment facilities. residential placement through at least the 10th week of the DtG
Students were of diverse ethnocultural backgrounds with ap- intervention prior to discharge.
proximately 30 % Caucasian, 39 % African-American, 26 %
Hispanic, and 4 % mixed ethnicity or other. All girls had a Intervention
history of childhood physical abuse, sexual abuse, or neglect
as documented by state protective services, and met criteria Do the Good (DtG)
for posttraumatic stress disorder (PTSD), as determined by
clinician diagnosis. From this sample of 88 girls, 62 were The DtG curriculum, which as defined above has been derived
voluntarily enrolled in the Doc Wayne Athletic League from components of empirically based and empirically sup-
(“DtG participants”) and 26 served as treatment-as-usual ported treatments for youth with behavioral dysregulation and
(“TAU participants”) comparison students (see Fig. 1). All histories of complex trauma exposure. The DtG curriculum
league players had observational behavior data from sporting trains coaches to facilitate skills through four sports-themed
events. Of the 62 in the league, 28 had available data on their therapeutic goal modules: “play to the whistle” (e.g., perse-
behavior and mental health. All 26 TAU participants had verance, putting aside frustration while pursuing a goal),
behavioral and mental health data available. All participation “show up” (e.g., commit to one’s best possible performance,
in this therapeutic sports league is optional with students awareness of emotional reactions to distress), “build your
enrolling each season on an elective basis. team” (e.g., leadership skills and responsibility-taking), and
The six participating residential treatment facilities were all “fill the tank” (e.g., provide support for one another, framing
designed in accordance with state Department of Education one’s games in terms of successes).
regulations and were each designed to serve adolescents with The DtG curriculum rotates on a seasonal basis and in-
severe emotional and behavioral problems and placement dis- cludes separate seasons for basketball, soccer and softball.
ruption. The six schools were interspersed across several sub- Evaluation data for all DtG participants in the present study
urban and metropolitan regions of a mid-sized state in the was drawn from review of routine clinical chart data captured
Northeastern United States. Comparison participants received at time points corresponding to the month immediately prior,
treatment-as-usual (TAU) in the same residential treatment during, and following the league’s 2009 basketball season.
setting as girls in the intervention. In order to be enrolled in Enrollment in the therapeutic sports league was voluntary.
the residential treatment program, girls must meet criteria for a Participants attended a once-weekly hour-long basketball
severe emotional disturbance as defined by the Clinician game played against a competing residential treatment facility
Assessment of Needs and Strengths (Lyons et al. 2003), a team over a 5-month season. Three games were held each
platform for documenting case history and clinician diagnoses. night (i.e., each school would play one game/night). Once
The majority of participants have current or prior involvement every 6 weeks, the league hosted a “skills clinic” in place of
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the game that taught basic basketball skills (shooting, drib- aggressive and out-of-control behavior. Physical restraints and
bling, etc.) and introduced the new skill module. time-outs were calculated by tallying the occurrence of each
event for the 10 weeks prior to the start of the program (“pre-
Coach Training Dtg”), and the last 5 weeks of the program and 5 weeks
following the conclusion of the program (“post-Dtg”). The
Coaches were both male and female, and had either high rationale for this time span was to allow for equal time periods
school diplomas or Bachelor’s degrees. None of the coaches of data collection with the assumption that the majority of
had any specialized mental health training beyond that of floor gains from the program would be evident by the latter third of
staff in residential programs, which includes training in plan- the program.
ning and implementing behavioral treatment plans according
to the therapeutic milieu of the residential program. All Mental Health When available, mental health was determined
coaches participated in a 24-h training course, with two full- using Achenbach’s Child Behavior Checklist (CBCL), a stan-
day follow-up courses during the season. The training was dardized instrument filled out by caregivers, therapists or
conducted by a coaching expert who designed the curriculum. teachers (In this case, it was filled out by the child’s therapist
In addition to teaching coaching-techniques, coaches were every 3 months; CBCL scores were sometimes unavailable if
provided with psychoeducation about the effects of trauma the child’s therapist had not filled out the instrument in a
on youth and how trauma symptoms may manifest during timely manner). The CBCL (Achenbach and Edelbrock
games. Between games, coaches would consult weekly with 1979; Achenbach et al. 1991) is a widely-used 118-item
the coaching expert on the prior game and make coaching instrument that can be reliably separated into Internalizing
goals for improvement (e.g., provide more specific praise) for (anxiety/depression, withdrawal, somatic complaints) and
the next game. Coaches were instructed throughout the game Externalizing (delinquency, aggression) subscales. Internal
by a coaching expert who encouraged their use of four target consistency has ranged from .89 to .93 in prior research
behaviors: circle-ups, one-on-one conversations with players, (Achenbach et al. 1991) and .91 for the current study. The
use of specific praise and building of a team identity. The CBCL has been found to have strong concurrent validity in
coaching expert would instruct coaches by consulting with clinical populations (Achenbach and Edelbrock 1979). Scores
them on the side lines and between plays. Using a parallel of 64 or higher are commonly considered the cutoff for
process which mirrored the coaching style he intended to clinically significant problems on a given subscale. Data was
encourage, he would provide specific feedback and note pos- collected pre- and post-Dtg.
itive coaching behaviors.
Observational Measures In order to examine whether the
Treatment as Usual (TAU) trauma-informed curriculum was successfully implemented,
coaches’ and players’ DtG skills utilization was tracked on a
Treatment as usual in the residential treatment setting involves weekly basis through live coding of observed behaviors in
structured activities, an adapted educational environment, each game, consistent with techniques outlined by Reid
psychiatric and medical consultation, and individual, group (1982). Time and budget limitations allowed for only one
and family psychotherapy. Participants’ stay is typically 12 to observer. In order to create the coding measure, the observer
18 months, with a minimum of 6 months. The programs are attended all coach trainings and consulted with the coaching
multidisciplinary and eclectic, drawing from trauma-informed expert to agree upon a set of observable behaviors for both
models including DBT, ARC, and Cognitive-Behavioral coaches and players (See Table 2 for list of behaviors). During
Therapy. Participants who elected to enroll in the DtG-based games, all players and coaches (4 per game, 2 per team) were
sports league continued with treatment as usual. Participants observed. Basketball was played in the 6-on-6 player format,
who elected not to enroll in the league participated in a group but players off the court awaiting their turn to play (ranging
activity in their residential setting during games. from 0 to 14 youth/game) were observed as well.
Measures Coach Skills Utilization Coach skill utilization was collected
via observation of coaching behaviors at each game. Tallies
Outcome Data were collected for each of the following target behaviors:
using circle-ups as a vehicle for teaching, praise and reflec-
Milieu Behavioral Data Behavioral data in the treatment mi- tion; one-on-one praise and feedback to students; use of
lieu were culled from chart review. The data included two specific praise when providing feedback (e.g., “the way you
variables: 1) need for physical restraints in programs, and 2) communicated with Vanessa during that play is a great exam-
need for use of time-outs in programs. Each of these events is ple of how to build the team, and demonstrates your commit-
the consequence of varying degrees of escalation of unsafe, ment to the group; I’m proud of you” versus a simple “good
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job”); and facilitation of a clear team identity (e.g., leading as a between-subjects factor. Post-hoc tests compared
team chants, bringing banners for their team). Data were whether children had significant changes in outcomes by
averaged from the first 3 weeks of play and the last 3 weeks group. T-tests of coaching and player DtG skills utilization
of play to examine the dissemination of training efforts among were used to examine differences from the start of the
coaches, and on-the-court improved behavior in players. season to the end of the season. Because of the small sample
Trauma-informed coaching skills utilization was summed size, we also report marginally significant effects between
across the entire game season for use as predictors of treatment probabilities of .05 to .10.
outcome.
Player Skills Utilization Student skills utilization was collect- Results
ed via observation of student game behaviors over a 5-month
period. Tallies were collected for each of the following target Sample Descriptives
behaviors: conflicts (e.g., losing of one’s temper, crying, ar-
guments with referees or other students), conflict resolution Each school brought 6–17 players each week; on average,
(e.g., apologizing or accepting responsibility for behavior, each team brought 9 students/week. Eleven coaches partici-
“holding” one’s temper when slighted), helping behaviors pated in DtG, 7 of which were male. All 62 DtG-participating
(clapping for injured players, checking in with injured players, students were included in the present evaluation for purposes
offering comfort/encouragement to team-mates), participation of live observation and coding of clinical skills acquisition
in coaching huddles or circle-ups (i.e., during teaching or exhibited in game behaviors.
reflection moments, offering praise to peers, asking questions,
providing suggestions to the team), communication with Research Questions
others on the court, and offering encouragement or praise to
peers. Student skills utilization was computed in the same Are players showing improvements in target outcomes of
manner as for coaches. behavior and mental health, compared to treatment-as-
usual peers?
Procedure
Each game was attended by a trained coder who observed Restraints and Time-Outs
target coach and player behaviors. Each occurrence of the
behavior was descriptively specified (e.g., “encouragement” A repeated measures ANOVA with a Greenhouse-Geisser
included verbal statements such as “good job,” “you can do correction determined there was a marginally-significant main
it,” “shake it off,” as well as non-verbal behaviors such as effect of frequency of restraints over time (F (1,49)=2.92,
high-fives). Games were open to the public and players were pJ Fam Viol
(p .05), but there was a significant
interaction between externalizing symptoms and treatment
condition (F (1, 21)=11.20, p DtG-Post**; TAU-Pre < TAU-Post+; DtG-Pre > TAU-Pre*
Post 61.98(1.54) 63.20(2.31) 60.77(2.03)
+
= pJ Fam Viol Fig. 3 Time-outs by group over time Fig. 5 Externalizing symptoms, as measured by the CBCL, over time significantly different pre-DtG (p
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Table 2 Coaches’ and players game behaviors of their behavioral dysregulation. Furthermore, the severity of
Number of occurrences per game their behavioral disturbances prevents them from integrating
into less restrictive family and school settings. Therefore, the
First month of Last month of fact that DtG participants showed improvements in behavior
season M(SD) season M(SD) and mental health is clinically meaningful. In particular, it is
Coaches’ game behaviors
intriguing that youth who appeared to be functioning worse
along certain dimensions at the outset (e.g., time-outs) were
Held circle-ups 2.5(1.05) 3.5(2.43)
able to demonstrate significant improvement across other
One-on-one with players 5.5(3.08) 11.5(4.51)+
outcome domains, and to improve relative to peers with less
Provided specific praise 5.16(2.93) 4.83(3.13)
severe behavioral problems. It is notable that in several cases,
Built team identity 3.00(2.28) 6.50(2.66)+
post-DtG data for children in the intervention and their TAU
Players’ game behaviors
peers were different at baseline and were not different at the
Engaged in conflict 2.67(3.01) 1.67(1.63)
end of the intervention, because the DtG group started out
Resolved conflict 4.00(2.00) 6.83(5.19)
worse and improved, while the TAU group started out better
Helped other player 1.16(1.17) 7.17(4.49)*
and declined. The improvement of mental health and behavior
Communicated with teammates 3.67(2.87) 5.83(5.31)
of youth in a sports condition is encouraging; however, why
Encouraged teammate 17.67(11.02) 24.33(11.61)+
the intervention group improves while the TAU group de-
Participated in circle-up 11.00(11.61) 6.17(5.08)
clines warrants additional inquiry.
+
= pJ Fam Viol
poses a potential threat to internal validity. This problem involvement impact outcome, will provide further insight into
may have been enhanced by missing data, particularly for overall program effectiveness.
mental health measures. Because the study methodology
relied upon blind chart review to protect confidentiality,
missing data could not be searched out for the purposes of
this study. However, data trends appear to provide strong
indications in support of this program, and it is of note that References
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